Why Are Benzodiazepines Addictive?

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Benzodiazepines (BZDs), including Valium, Xanax, and Klonopin, have a potential for dependency and addiction. According to Psychiatric Services, "30.6 million adults (12.6%) reported past-year benzodiazepine use annually . . . and 5.3 million (2.2%) with misuse." Misusing benzodiazepines has the potential to cause severe health side effects. Pathways Recovery Center uses evidence-based methods and alternative holistic therapies to treat benzodiazepine addiction.  

The prevalence of benzodiazepines has made it difficult for people to recognize their potential dangers. However, benzodiazepine dependency and addiction continue to increase. Medical professionals frequently over-prescribe the drugs and may fail to properly educate clients on the high potential for misuse. 

Benzodiazepines 101: An Overview

According to the Drug Enforcement Administration (DEA), "Benzodiazepines are depressants that produce sedation and hypnosis, relieve anxiety and muscle spasms, and reduce seizures." The effects of benzodiazepines slow down the central nervous system (CNS) and cause people to feel relaxed or drowsy. 

Benzodiazepines are a Schedule IV drug with the exception of flualprazolam, etizolam, clonazolam, flubromazolam, and diclazepam, which are considered Schedule I drugs. Schedule IV drugs have a low risk of dependency and addiction, while Schedule I drugs have a high risk of dependency or addiction. 

Some of the most common benzodiazepines include: 

  • Alprazolam (e.g., Xanax)
  • Lorazepam (e.g., Ativan)
  • Clonazepam (e.g., Klonopin)
  • Diazepam (e.g., Valium)
  • Temazepam (e.g., Restoril)

Benzodiazepines are used to treat mental and physical health issues, including: 

  • Anxiety and panic disorders 
  • Insomnia and other sleep disturbances
  • Seizures and epilepsy 

Benzodiazepines may also be used as anesthesia before surgeries or other medical procedures. 

The drug is dangerous when misused despite the generally low risk of dependency when used for short-term treatment. Taking the medication for longer than recommended has the potential to cause severe symptoms and side effects. According to Neurology International, "Regular use of BZDs has been shown to cause severe, harmful psychological and physical dependence, leading to withdrawal symptoms similar to that of alcohol withdrawal." Individuals with a personal or family history of substance abuse are more likely to become dependent on prescribed benzodiazepines. 

The Chemistry Behind the Addiction

Benzodiazepines directly impact the release of the neurotransmitter gamma-aminobutyric acid (GABA). Studies have shown that "[d]isorder in GABA signaling is implicated in a multitude of neurologic and psychiatric conditions." Benzodiazepines slow the central nervous system by increasing the effectiveness of GABA receptors, causing a sedative effect. 

Some of the most common potential side effects of benzodiazepines include: 

  • Muscle relaxation 
  • Slowed movements 
  • Anterograde amnesia
  • Emotional numbness
  • Drowsiness

The calming effect of benzodiazepines makes the drug an excellent treatment for various mental health issues. For example, generalized anxiety disorder (GAD) may cause people to experience a range of disruptive symptoms. The sedative effect of benzodiazepines reduces anxiety symptoms and helps people achieve emotional stability. Benzodiazepines have a significant impact on mood and behavior. In rare cases, some people prescribed benzodiazepines develop disinhibited behaviors, including anger, irritation, violence, rage, or uncharacteristic impulsivity. 

The drug is highly effective for treating a wide range of issues when used for a month or less. However, anyone using benzodiazepine for over three months may experience substantial changes to neurotransmitters and various body systems. Prolonged use of benzodiazepines changes brain chemistry. A primary side effect of long-term benzodiazepine use is dysregulation of the neurotransmitter dopamine. 

Physical Dependence vs. Psychological Addiction

Physical dependence on benzodiazepines and other substances begins with increased tolerance. Over time, it takes more of the substance to achieve the same desired results. Once someone becomes dependent, they may experience withdrawal symptoms if they abruptly stop taking the drug. According to the Food and Drug Administration (FDA), "[S]ome patients have had serious withdrawal reactions after benzodiazepines were stopped suddenly or the dose was reduced too quickly." Sometimes, "patients experienced withdrawal symptoms lasting many months." 

In addition to physical symptoms, individuals may also experience psychological dependency and addiction. Symptoms of psychological addiction include: 

  • Cravings
  • Emotional reliance on the drug
  • Compulsive use of the drug 
  • Impulsive behaviors 
  • Intrusive thoughts
  • Feeling depressed or anxious when unable to take the substance 
  • Denial of substance misuse 

The exact causes of benzodiazepine addiction and dependency are unknown. However, researchers believe it involves the drug's ability to affect GABA and dopamine. According to Nature, "Addictive drugs increase the levels of dopamine and also trigger long-lasting synaptic adaptations in the mesolimbic reward system that ultimately may induce the pathological behavior." Regardless of the exact cause of benzodiazepine dependency and addiction, the drug can cause severe mental and physical health issues. 

The Risks of Long-Term Benzodiazepine Use

Some of the potential side effects of misusing benzodiazepine include the following: 

  • Physical effects: extreme drowsiness, lightheadedness, dizziness, confusion, memory issues, slurred or disordered speech, and loss of equilibrium 
  • Emotional effects: anxiety, depression, paranoia, and extreme irritability or aggressive behavior 
  • Cognitive effects: impaired motor coordination, decreased verbal learning abilities, reduced processing speed, and decreased visuospatial skills

The side effects of misusing benzodiazepines increase in severity and complexity when people misuse multiple substances simultaneously. Mixing benzodiazepine and illegal drugs is highly dangerous. In many cases, individuals misusing illicit substances have no way of knowing the exact nature of the substance they are ingesting. Combining unknown substances with benzodiazepines can be deadly. Individuals should inform clinicians about any substances, including over-the-counter and natural herbal remedies they take on a regular basis. 

Some substances should not be combined with benzodiazepine, including:

  • Alcohol 
  • Illicit drugs 
  • Opioid pain relievers 
  • Other medications that cause drowsiness 

Misusing additional substances, especially alcohol or opioids, while taking benzodiazepine increases the risk of overdose, severe illness or injury, and death. According to the Centers for Disease Control and Prevention (CDC), "Benzodiazepines were involved in nearly 7,000 overdose deaths in 23 states from January 2019-June 2020 – 17% of all drug overdose deaths." Individuals can avoid the risk of accidental overdose or death by getting help from trained addiction recovery specialists. The care team at Pathways Recovery Center uses evidence-based methods to help clients heal from substance use disorder (SUD) and manage any co-occurring conditions. 

Withdrawal and the Challenges of Discontinuation

People who stop taking benzodiazepines or reduce their dose significantly after becoming dependent on the drug may experience withdrawal symptoms. The symptoms exist along a spectrum; everyone has a unique experience when transitioning off the drug. The severity of symptoms and how long withdrawal lasts differ from person to person. Some individuals have long-term side effects and severe symptoms, while others may only feel mild side effects. Many factors contribute to the withdrawal experience. 

Some of the most common withdrawal symptoms and side effects include: 

  • Severe heart palpitations
  • Muscle tremors and stiffness 
  • Vertigo
  • Uncontrollable motor movements
  • Loss of coordination
  • Suicidal ideation 
  • Seizures 
  • Blurred vision
  • Anxiety 
  • Appetite changes 
  • Sleep disturbances

Individuals with co-occurring opioid use disorder (OUD) have an increased risk of complications during withdrawal. According to Therapeutic Advances in Psychopharmacology, "The co-occurring abuse of opioids and BZD, as well as increases in BZD abuse, tolerance, dependence, and short- and long-term side effects, have prompted a worldwide discussion about the challenging aspects of medically managing the discontinuation of BZDs. Abrupt cessation can cause death." Medical detox provides the best outcomes. Detox programs ensure clients have access to a team of trained recovery experts to address any unexpected complications or challenges during withdrawal. In addition, addiction recovery services during detox and withdrawal reduce the risk of relapse or overdose. 

The severity and duration of withdrawal depend on several factors, including the type of benzodiazepine misused, how quickly it was tapered off, the client's general health, and any co-occurring conditions. During treatment, clinicians educate clients on potential symptoms and provide them with the tools and resources to manage their condition. Medically supervised detox is the best way to ensure clients remain safe and receive appropriate treatment for their symptoms. 

Benzodiazepine Addiction Treatment at Pathways Recovery Center

Pathways Recovery Center uses evidence-based and alternative holistic therapies to treat clients with SUD. According to Frontiers in Psychiatry, "[E]vidence shows the effect of [complementary and alternative medical] practices, such as mindfulness meditation (MM) and motivational enhancement, in decreasing SUD relapse and substance-related injuries . . . With some complementary and alternative therapies for SUDs, such as mind–body therapies, acupuncture, and meditation, proving to be effective." Clients are encouraged to utilize holistic therapies when possible to help manage symptoms.

Some popular alternative holistic therapies include: 

  • Art and music therapy 
  • Massage therapy 
  • Sound bath therapy
  • Yoga 
  • Breathwork
  • Stress management

Benzodiazepines are often used to treat anxiety and sleep disturbances. Holistic alternatives for addressing these issues can increase the effectiveness of psychotherapy and other evidence-based treatments by reducing stress and promoting mindfulness. 

The Importance of Tailored Treatment Plans

Treatment plans should be tailored to each client's unique needs and consider their physical, emotional, and spiritual well-being. Pathways Recovery Center offers personalized programs to ensure the best possible outcome for clients recovering from SUD. 

Tailored treatment generally includes: 

  • Detox 
  • Psychoeducation
  • Individual and group psychotherapy
  • Counseling 
  • Aftercare planning 
  • Alumni services

Every level of care and stage of recovery benefits from personalized care. Clients participating in individualized care have additional opportunities to address potential problems and underlying issues before transitioning out of care. Tailored treatment reduces the risk of relapse and improves mental health during early recovery.

Addressing Co-Occurring Mental Health Disorders

Many people who misuse benzodiazepines have co-occurring mental health disorders. SUD and co-occurring conditions require simultaneous treatment to reduce stress and symptoms during recovery. 

The most common co-occurring mental health issues include:

  • Opioid use disorder (OUD) 
  • Anxiety disorders 
  • Panic disorders

Clinicians use comprehensive treatment services to manage co-occurring conditions. Co-occurring disorders may cause more severe or complex symptoms during detox and withdrawal. Pathways Recovery Center's integrative and personalized treatment plans ensure clients have access to essential support services for dual diagnosis. 

Prevention and Safer Use

Preventing benzodiazepine addiction requires healthcare providers and individuals to be safer about dispensing and using the drug. 

Taking benzodiazepines responsibly involves doing the following: 

  • Always taking the drug as prescribed 
  • Discussing any concerns or thoughts of misuse with a medical professional
  • Informing the prescribing medical professional of any other substances being taken, including over-the-counter medications
  • Avoiding benzodiazepines when other treatments provide the same effects 
  • Being mindful of changes in mood or behavior while taking the drug 

The best way to reduce the risk of dependency or addiction is to frequently check in with a medical professional and avoid using benzodiazepines for longer than recommended. According to the British Journal of General Practice, "Benzodiazepines should only be prescribed in the lowest effective dose for the short-term relief (maximum of 2-4 weeks) of severe anxiety or panic disorder, usually in an acute crisis situation."

The Significance of Doctor-Patient Communication

Doctor-patient communication is critical to ensuring warning signs of dependency and addiction are not missed. Medical professionals have an obligation to educate clients and keep an open line of communication. A person's ability to communicate effectively with their care provider impacts how they act when taking prescription drugs. 

Individuals improve communication with their family doctor, care team, or other medical professionals by doing the following: 

  • Reporting any changes to physical or mental health 
  • Being honest about the effectiveness of the drug and any potential signs of tolerance or dependency
  • Checking in regularly to monitor symptom severity and recovery progress

Benzodiazepines are meant for acute conditions and short-term treatment. The drug should be avoided if alternative treatments are available. 

Alternative Care for Conditions Treated With Benzodiazepines

Benzodiazepines are overprescribed, and often, alternative treatments provide similar relief from symptoms. A few non-addictive substances doctors use to address conditions treated with benzodiazepines include: 

  • Selective serotonin reuptake inhibitors (SSRIs) 
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Beta-Blockers
  • Buspirone 
  • Hydroxyzine (Vistaril)

Benzodiazepines should be avoided whenever possible or used at the lowest dose for a very short period of time. According to the Department of Veterans Affairs (VA), "Serious adverse consequences associated with benzodiazepines" include:

•Depressed mood 
•Cognitive impairment
•Falls/hip fractures 
•Traffic accidents 
•Accidental overdose, 
particularly when combined
with other sedatives (e.g. 
alcohol, opioids)

Avoiding benzodiazepines when possible reduces the risk of serious injury, illness, overdose, or death. 

Pathways Recovery Center - Residential Treatment and Detox

Detox and addiction recovery treatment provides clients with the support they need to heal and build a healthier future. Pathways Recovery Center is committed to helping clients overcome addiction and achieve long-term sobriety. The care team collaborates closely with clients and their families to reduce the risk of relapse and ensure a positive recovery experience. 

Detox services include: 

  • Case management
  • 24/7 medical supervision
  • Therapy 
  • Peer support 
  • Medication management

Medically assisted detox provides clients and their families peace of mind and ensures a safe withdrawal experience. 

Education Reduces the Risk of Benzodiazepine Misuse

Mental health and addiction education is a critical tool for reducing benzodiazepine misuse. People prescribed the drug should know how to spot the warning signs of addiction and be made aware of the potential for abuse. Communities and prescribing medical professionals are obligated to educate clients and families about the realities of benzodiazepine addiction. 

Community education reduces the risk of prescription benzodiazepine misuse by doing the following: 

  • Ensuring people understand what constitutes prescription misuse 
  • Providing resources and additional information  about treatment options
  • Ensuring people understand the severe and life-threatening nature of untreated benzodiazepine addiction

Treatment programs use psychoeducation to ensure clients and their loved ones better understand their condition and the potential side effects. Studies have shown that "including family members in psychoeducation can improve treatment outcomes for clients, reduce returns to use, and enhance the entire family's functioning and well-being." Clients are encouraged to take an active role in their treatment planning during detox and early recovery. The more clients understand about their disorder, the better equipped they are to manage long-term recovery. 

Get Help Today

Individuals struggling with benzodiazepine misuse may not always recognize the dangers of their condition. Friends and family play an essential role in ensuring people with SUD get the help they need. Pathways Recovery Center encourages anyone concerned about benzodiazepine misuse to contact a medical professional today. Early intervention and treatment often ensure better outcomes and fewer long-term side effects.

Benzodiazepines are one of the most prescribed drugs in America. The potential for dependency and addiction makes them potentially dangerous if they are used in ways other than prescribed or for longer than a month. Unfortunately, many doctors overprescribe benzodiazepines, increasing the risk of dependency and addiction. Individuals struggling with benzodiazepine dependency or addiction often have underlying health issues and co-occurring mental health disorders. Treatment must address all issues affecting recovery to ensure the best outcome. Pathways Recovery Center uses personalized treatment plans to ensure clients receive the care they need to recover from benzodiazepine addiction. To learn more about our treatment programs and services, call our office today at (888) 771-0966.

Clinically reviewed by 

Moses Nasser
Dr. Moses Nasser, a double board-certified physician in Family Medicine and Addiction Medicine, with expertise in holistic healing, addiction medicine, and psychiatric care, holds an X-waiver to prescribe buprenorphine and has extensive experience in mindfulness-based customer service and medication-assisted treatment.

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